Wednesday, August 26, 2015

Evening Routines

OMDG posted today about her challenge with evenings, which got me reflecting on my own evening routine since starting back at work.  When I was on holidays, my plans for my work evenings were very ambitious - cook tasty dinners with my girlfriend, clean the kitchen, take care of housework/paperwork, exercise, and read stimulating and erudite books.  Shockingly, the reality has been somewhat less impressive.  Despite not actually working that hard yet (I'm only working about half-time at the moment), I've been coming home mentally exhausted every day, and I haven't been able to motivate myself to do most of the things I would like to.

Currently, my post-work schedule looks something like this:

1)  Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway.  Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.

2)  Cook dinner with my girlfriend.  This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.

3)  Spend way too much time on the computer.  Facebook, blogs, news, repeat.  I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time.  On a good day, I write a blog post of variable quality.

4)  Watch something on Netflix with my girlfriend.  Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.

5)  Look at the stack of library books on my coffee table.  Decide it isn't worth the effort.  Possibly watch another Netflix show, usually of lower quality than Human Planet.

6)  Feel progressively more exhausted.  Resist the urge to go to bed like a reasonable human being.  Repeat item #3.

7)  Realize it's past my bedtime.  Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done.  (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)

8)  Finally get to bed much later than I should.  Realize that eight hours of restful sleep has become an impossible dream.

9)  Lie awake staring at the ceiling, regretting all of the things I didn't do.

This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work.  Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.

How happy are you with your evening routine?

Sunday, August 23, 2015

A Post on Parenting by a Childless Woman

One of my good friends from medical school has three children between the ages of 7 months and 5 years.  When it came time for her to go back to residency after her first maternity leave*, she and her husband were faced with the inevitable question of who would take care of the child.  From a financial perspective, it made much more sense for him to stay home, so they decided to go against the societal norm and make him the stay-at-home parent.

Now three children into the process, it seems to be working very well for them.  My friend thrives on her work as a physician and earns enough to support the family, while her husband (mostly) enjoys being the primary caregiver.  Whenever I visit, he is the person that the children go to first, whether for food or comfort or just to whine about one of their many grievances. 

Although the arrangement is mostly good, it does come with its own set of challenges.  While there is a huge network of supports available to mothers from the beginning of pregnancy onwards (exercise classes for pregnant moms, lactation groups, mom-and-baby programs), there is very little for fathers who choose to stay home with their kids.  There's the constant judgement of women who choose not to stay home with their children.  And then there's the never ending societal narrative that says that women should be the caregivers, not men.  It's present in ads for baby products that feature only mothers, in the language we use to describe parenting (e.g. talking about fathers who "help" with the kids or who "babysit" them when the mother is away), and in the way we label restrooms for parents with kids as "Mommy and Me" restrooms.

Even though I don't have children, and probably never will, these things frustrate me to no end.  They frustrate me because they make it unnecessarily hard for fathers to stay home with their children, even when that's what works best for their families.  They frustrate me because they perpetuate the idea that a woman's role is to raise the children, regardless of whether she would prefer to be in the workforce.  And they frustrate me because they limit us to traditional gender roles, even though two X chromosomes don't automatically make a person a better parent than an X and a Y.

We have to start doing better.

*Unlike in the States, Canada has a great parental leave policy that allows the mother and/or father to take a combined total of 50 weeks of partially paid leave.

Friday, August 21, 2015

Doing the Unthinkable

Yesterday afternoon I left work at 1 PM.

This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours.  What made it amazing is that I had absolutely nothing to go to.  I was simply done my work for the day*.

As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day.  The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?"  It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home:  if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.

As an attending, on the other hand, I set my own schedule (within certain limits).  I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all).  The freedom is awesome!  And while I have no intention of abusing this freedom, I do intend to make the most of it.  Before starting work, I decided that I will no longer stay at work just to make an appearance.  If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital. 

I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM.  But on the days when I can go home in the early afternoon, I fully intend to do it.  And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.

*Of course, as soon as I left the hospital I got paged to go back, but such is life.

**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry.  My chosen career is awesome.

Wednesday, August 19, 2015

It Only Took Two Days

As a resident, it used to drive me nuts when I would try to page my attending and he or she wouldn't respond to my page.  It was particularly annoying when it was the middle of the night and all I wanted to do was review a case quickly so that I could get to my call room and possibly be horizontal for a few minutes.  Whenever it happened to me, I would vow that I would never, ever fail to answer my pager as an attending.

Guess which attending woke up this morning to discover that she'd slept right through a middle of the night page?

Tuesday, August 18, 2015

Choices

Last night, my girlfriend took me to my favourite Ethiopian restaurant for a meal to celebrate my first day as an attending.  We ordered one vegetarian platter and one meat platter, which is too much food for two people to eat, but not quite enough food to leave a good serving of leftovers.  After my girlfriend had given up, while I was still trying to finish off every last tasty morsel, we had the following conversation.

Girlfriend:  "You know...if you stop eating now, we could share a mint Oreo Blizzard for dessert."

Me (pausing while bringing a handful of food to my mouth):  "What if I want to keep eating, but I also want to have a mint Oreo Blizzard for dessert?"

GF:  "Well...you're an adult and you can make choices for yourself.  My only request is that you not vomit in the car on the way home."
 
Me (reluctantly returning the handful of food to the plate):  "You never let me have any fun." 

Monday, August 17, 2015

That Wasn't Horrible

When I was planning my schedule a few months ago, I thought that I would "start off easy" by being on the consult service for the first two weeks and only doing one or two half-day clinics per week.  I spent months (and months and months) on the consult service as a fellow, so being on service as an attending shouldn't be all that different from what I was doing before, and it guarantees me a minimum income to help with the bills that have piled up after seven weeks of vacation.

The only problem with my plan?  I scheduled my first clinic for the morning of my very first day.  At the inner city clinic where I've only worked twice and therefore am unfamiliar with pretty much everything (like the bloody EPR).  The clinic with the very complicated patients who actually require time.

In the end, my two-and-a-half-hour-long clinic took four hours, followed by a full hour of charting and paperwork.  Amazingly, I stayed calm throughout it and didn't once cry or freak out.  And it was actually (dare I admit it) a tiny bit of fun.  My nurse is absolutely amazing with both me and my patients, and she was the main reason why I didn't go insane when my clinic ran horribly over.  It also helped that there was nothing pressing on the consult service, so it was okay that I showed up at the other hospital at 3 PM.

Maybe this attending gig will be bearable after all.

Sunday, August 16, 2015

Habits - Work

It's the evening before I return to work, and my feelings are alternating between excited and distraught and absolutely terrified.  It definitely feels like time to go back (there is almost nothing left on my to-do list), but at the same time I'm dreading the first day.  I start with a busy clinic and I'm on home call for the first 12 days, so it won't be an easy return.  But I can do this.

Right?

I'm hoping that, if I start off on the right foot, I can set myself up for long-term success.  With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning.  For those of you who work in medicine, is there anything else you'd add?  Any advice?  (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)

Record Billing Information as it Happens:

This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid.  While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do.  The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.

Finish my Dictations Every Day:

So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations.  Which means so much unnecessary stress!  When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending.  It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.

Devote Time and Energy to Teaching:

Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time.  As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return.  Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service.  I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today.  The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).

Read for at Least Three Hours per Week:

Medicine changes.  Every day, I get emails from journals about all of the articles that I should be reading.  In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.

Research: 

This is worthy of a post all its own.  I don't even know what to say here.  I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research.  Soooo.....we'll just have to see where this one ends up.  I had hoped to have this figured out by the end of my vacation, but not so much.

Put Patient Care Above Other Considerations:

This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room.  Their outcomes are more important than how much I bill or what time I leave work at the end of the day.  While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.